May 30, 2024
Cognitive dissonance — acting in ways that conflict with your own stated beliefs, or holding two contradictory beliefs at once — is harder to sustain the closer you are to patients, which is probably why moral injury and burnout hit bedside clinicians hardest. John Lee, MD, a practicing emergency physician...
May 23, 2024
There’s a 31-member AMA committee that, under a sole-source contract with CMS dating back to the late ’80s, decides the relative value of every medical procedure — and 22 to 25 of those 31 seats go to specialists, leaving primary care with just five or six. Brian Klepper, PhD, a longtime healthcare analyst and...
May 16, 2024
When a TPA gets acquired by a health plan, history suggests it stops being a TPA and starts acting like a full health plan — ancillary fees, opt-out-proof bells and whistles, and all, whether or not that's what the self-insured employer actually wants. Elizabeth Mitchell, president and CEO of the Purchaser...
May 9, 2024
It costs providers roughly 14% of a transaction’s value just to get paid for it, and payers tack on another 5% to 15% just to pay it — putting 20% to 30% of every healthcare transaction into pure administrative waste before anyone talks about redundant care or unnecessary procedures. David Scheinker, PhD, executive...
May 2, 2024
Practicing medicine without considering pharmacy is like getting to the 90-yard line, putting down the ball, and walking off the field — and yet almost no mainstream contract holds a PBM accountable for the downstream medical costs caused by suboptimal pharmacy benefit design. Dan Mendelson, CEO of Morgan Health...